Name

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* 1. Name

E-Mail

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* 2. E-Mail

Cell Phone #

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* 3. Cell Phone #

Interest Level

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* 4. Interest Level

What School do you attend?

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* 5. What School do you attend?

Have you begun your registration at http://www.conferenceregistrationtool.com/beginRegistration.seam?conferenceId=2743

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* 6. Have you begun your registration at http://www.conferenceregistrationtool.com/beginRegistration.seam?conferenceId=2743

How much scholarship would you like to request?

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* 7. How much scholarship would you like to request?

We do not want finances to prevent you from attending the retreat, but our funding is also limited. Is there any other financial information that would be helpful for us to know in making a decision (i.e. I'm working 2 jobs to pay for college, my bank account is $65 and has to last me the semester, I went on an overseas mission trip in the summer and wasn't able to earn money)? 

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* 8. We do not want finances to prevent you from attending the retreat, but our funding is also limited. Is there any other financial information that would be helpful for us to know in making a decision (i.e. I'm working 2 jobs to pay for college, my bank account is $65 and has to last me the semester, I went on an overseas mission trip in the summer and wasn't able to earn money)? 

Thanks for filling this out. We'll try to get back to you as soon as we can.

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* 9. Thanks for filling this out. We'll try to get back to you as soon as we can.

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